By Carey Goldberg
Boston Globe Staff / December 15, 2008
Sexual “numbness.” Lack of libido. Arousal that stalls.
Such sexual symptoms have long been known side effects of the popular Prozac class of antidepressants, but a growing body of research suggests that they are far more common than previously thought, perhaps affecting half or more of patients.
And a handful of recent medical and psychological journal articles document a small number of cases in which sexual problems remain even after a patient goes off the drugs.
“This is such an upsetting issue,” said Aline Zoldbrod, a Lexington psychologist and sex therapist. “There are people for whom SSRIs are really life-saving, I think, but the idea that someone would have to choose between getting out of the darkness of depression and having a good sex life is horrible.”
Current warnings on the labels of selective serotonin reuptake inhibitors, or SSRIs, cite early studies in which the prevalence of sexual side effects was lower: 4 percent for Prozac, for example, and ranging from 0 to 28 percent for Paxil.
But more recent studies, in which patients were more likely to be asked about specific sexual side effects and thus more likely to report them, suggest that the ballpark range of those affected by SSRIs is between 30 percent and 50 percent, said researchers including Dr. Richard Balon, a psychiatry professor at Wayne State University who studies the symptoms.
That would translate into millions of affected sex lives among the estimated 1 in 8 American adults who have tried these antidepressants in the past decade or so. Some studies have found the range still higher.
In fact, the dampening sexual effects can be so dramatic that in recent years, the antidepressants have become the leading treatment for premature ejaculation, a study last year found, though they are not approved for that use by the FDA.
“I tell patients there’s a good chance they may have sexual problems” while on the antidepressants, “with the most frequent being delayed orgasm,” Balon said.
Representatives of some of the companies that make SSRIs pointed out that sexual dysfunction is complex to measure. Patients may be reluctant to discuss it, and it is hard to distinguish issues caused by the drug from problems caused by the underlying mental illness, by diseases such as diabetes, or by other medications, they said. The Prozac label states that “There are no adequate and well-controlled studies examining sexual dysfunction” of patients on Prozac.
Balon and other researchers agree that the issue is complex and the science imperfect: Mental illness can often impair sexuality, and the studies on SSRI-related sexual dysfunction have been small. “The [pharmaceutical] industry, understandably, has no interest in funding this,” Balon noted.
But methods for detecting sexual side effects have improved. Researchers have found that asking patients about the sexual effects directly – As in asking, “Have you been having trouble reaching orgasm?” – instead of waiting for spontaneous complaints yields a major increase in reports. And a wide variety of studies point toward higher prevalence, they say – including some involving people free of underlying illness that could explain the symptoms.
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